Provider Demographics
NPI:1821224346
Name:DORIS BERGERON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:DORIS BERGERON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-223-3733
Mailing Address - Street 1:3355 DICKSON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4034
Mailing Address - Country:US
Mailing Address - Phone:907-223-3733
Mailing Address - Fax:907-333-0298
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-223-3733
Practice Address - Fax:907-333-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty